Here is the text we could read:
IN THE CIRCUIT COURT OF _________________________________________________________________, ALABAMA
(Name of County)
STATE OF ALABAMA
TO THE CIRCUIT COURT CLERK
I, _____________________________________________________, ON BEHALF OF ____________________________________
___________________________________________ (name of surety insurer), REQUEST THAT THE COMPANY BE AUTHORIZED
TO EXECUTE BONDS IN ITS NAME AS SURETY RETURNABLE TO THE CIRCUIT, DISTRICT AND MUNICIPAL COURTS OF
THIS COUNTY, AND DO CERTIFY THAT:
I am a resident of the State of Alabama, residing at:
______________________________________________________________________________________________________
(county)
(address)
(city)
The company is duly authorized to do business in the State of Alabama, and has its principal of business within the State of
Alabama at:
______________________________________________________________________________________________________
(county)
(address)
(city)
Its resident agent for service of process is: ____________________________________________________, whose address is
______________________________________________________________________________________________________
(county)
(address)
(city)
I am a/the ______________________________________________________________ of the above-named company which is
a ____________________________________________________________________ organized under the laws of the State of
________________________________________, and I am duly authorized to execute this certificate on its behalf.
. All appearance bonds shall be executed in the name of___________________________________ (name of insurer), as surety
by the agents listed or appointed in the Qualifying Power of Attorney presented to the court or any other Qualifying Powers of
Attorneys filed with the circuit clerk of the county.
4. All agents listed or appointed in such Qualifying Powers of Attorneys will be licensed by the Department of Insurance, prior to
such appointments.
5. _________________________________________________________________________________ (agent), which represents
_______________________________________________________________________________________ (surety insurer) in
________________________________ county, has no owners or other persons having a direct or indirect financial interest in
____________________________________________________________ (bonding company), who have been convicted of a
felony or a crime involving moral turpitude except ______________________________________________________________
____________________________________________________________ who have been convicted of the following offenses:
___________________________________ and who have been pardoned or has had a restoration of civil rights (see attached).
6. _____________________________________________________________________ has no knowledge of any final forfeitures
against ___________________________________________________________________________________ (surety insurer)
for which ______________________________________________________________________________(bonding company)
has caused to be executed by any of its representatives, which have been final for more than thirty days and of which
________________________________________________________________________ (surety insurer) or its representatives
have no petitions, motions or other type litigation pending that have not been paid arising out of a surety undertaking.
7. No agents of___________________________________________________________________ (surety insurer), as listed in the
Qualifying Power of Attorney (attached) who have the authority to execute appearance bonds in its behalf, and no persons
having a financial interest, direct or indirect, in the ownership or management of ______________________________________
(bonding company) which presents _____________________________________________________________ (surety insurer)
in the execution of appearance bonds, are attorneys, judicial officials, persons authorized to accept an appearance bond, or
agents of an attorney, judicial official, or person authorized to accept an appearance bond.
This certificate must be executed by a “licensed agent of the professional surety company who is a manager or an owner or a
president of a corporation, company, partnership, or other entity that represents the professional surety company.”
*
State of Alabama
Unified Judicial System
orm CR-12 (front) Rev.4/99
CERTIFICATE OF PROFESSIONAL
BONDSMAN
(Professional Surety Company)
Date Filed
F
1.
2.
3
Form CR-12 (back) Rev.4/99
CERTIFICATE OF PROFESSIONAL BONDSMAN (Professional Surety Company)
8. The only persons who have any financial interest, either direct or indirect, in
___________________________________________________________________________________ (bonding company) are
(Include the names and addresses of all persons, officers, employees and agents the agency, company or corporation
representing the professional surety company).
Name
Address
Nature and Extent of interest
________________________________ ________________________________________ _____________________________
________________________________ ________________________________________ _____________________________
________________________________ ________________________________________ _____________________________
________________________________ ________________________________________ _____________________________
________________________________ ________________________________________ _____________________________
________________________________ ________________________________________ _____________________________
9. None of the above named persons have, within the last two years immediately preceding this date, violated any provisions of
the Bail Bond Reform Act or of the Alabama Rules of Criminal Procedure or any court order, relating to the making of bonds.
10. __________________________________________________________________________________
(bonding company),
a/an ______________________________________________________________________,
(corporation/company) does
represent _______________________________________________________________________ (surety insurer) and certain
employees of ____________________________________________________________________ (bonding company) are
licensed agents of ____________________________________________________________________ (surety insurer).
11. _______________________________________________________________________ (name of insurer) has a sufficient
financial net worth to satisfy the obligations which it may enter into as a surety, taking into consideration all other outstanding
obligations and liabilities.
12. Should the Qualifying Power of Attorney for the named agents be terminated or the license of such agents or underwriters be
revoked, suspended or cancelled, the affiant herein agrees to promptly notify the court of such action and the agent’s authority
to execute appearance bonds shall be withdrawn until otherwise qualified pursuant to the Bail Bond Reform Act or Rule 7,
Ala.R. Crim.P.
HAVE NOTICE THAT FALSE STATEMENTS ARE PUNISHABLE AS PERJURY AND CERTIFY THAT THE ABOVE STATEMENTS
ARE TRUE AND CORRECT.
worn to and subscribed before me this
____________________________________
date
________________________________________________________
Affiant’s Signature
________________________________________________________
____________________________________
Clerk of the Circuit Court
________________________________________________________
________________________________________________________
Affiant’s Address
________________________________________________________
Social Security Number
________________________________________________________
Telephone Number
I
S
